Medical marijuana raises too many unanswered issues

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Seriously ill patients who feel that marijuana eases their pain should have an opportunity to get legal access to it. Those skeptical of its benefits should consider the claims of cancer patients that marijuana curbs the nausea associated with some forms of chemotherapy. Then there are the people with many different conditions who insist that marijuana provides faster relief, with fewer side effects, than more powerful opiates.

That’s why so many states, including in New England, are seeking ways to make medicinal marijuana legally available. The question is how to do it. States like Colorado and California jumped ahead of the pack in allowing medical-marijuana clinics, with dubious results; their loosely written laws made the drug so widely available that there are 1,000 clinics in Los Angeles alone. The ballot measure facing Massachusetts voters contains more safeguards: There would be a maximum of 35 nonprofit treatment centers across the state in 2013; patients would be required to have a relationship with any doctor who recommends marijuana as a painkiller.

But the measure leaves voters with a number of other substantive questions: How can the state guarantee a safe supply of marijuana? And under what terms is marijuana usage safe?

The answers, unfortunately, aren’t clear enough. Because marijuana has been illegal, and isn’t regulated through the Food and Drug Administration, there aren’t consistent guidelines for its use. Without such rules, Massachusetts shouldn’t put itself in the position of dispensing a drug it can’t safely regulate. Despite some persuasive arguments in favor of marijuana’s medicinal properties, voters should check “no” on Question 3.

While it is drafted more carefully than many medical-marijuana laws in other states, Question 3 is essentially an attempt at an end-run around the FDA, which refuses to regulate it. Proponents insist that the political stigma surrounding marijuana — a stigma buttressed by the frequently voiced concern that it can be a “gateway drug” to heroin or cocaine — makes it untenable for the FDA to allow medical marijuana. Therefore, state laws are the only vehicles for getting the drug legally into the hands of patients, some of whom are using it anyway via the black market.

Indeed, patients talk of their frustrations at having to go to drug dealers for the medicine that makes them feel better. Though possession of small amounts of marijuana was decriminalized four years ago under another ballot initiative, growing and selling marijuana remains illegal in Massachusetts.

Some patients argue that even if the legal process outlined in Question 3 lacks FDA-level protections, it’s still a lot safer than buying the drug on the street. That’s certainly true: Under Question 3, the state’s Department of Public Health would have open-ended powers to regulate marijuana clinics. On the street, there are no protections.

The only truly safe way to legalize marijuana will be through the FDA.

But even if Question 3 marks an improvement over the black market, it leaves too many questions unanswered:

For which conditions, in particular, is marijuana effective at stopping pain? The law doesn’t say; doctors are free to decide.

How much of a dosage is adequate? There’s little evidence to go on.

When is marijuana use contraindicated — say, because of side effects when used alongside other types of medication? Again, it’s not been thoroughly tested.

With any other legal drug, patients would expect straight answers — they’d assume, almost unconsciously, that the FDA was protecting them. There’s no such backstop for medical marijuana. Even the wisest physicians wouldn’t have enough data to make definitive judgments.

If the choice in Question 3 were only whether to provide a legal route to obtain medical marijuana for those who are already using it, it would be easier to overlook the unanswered questions; clearly, some protections are better than none. But passage of Question 3, and the approval of legal growers and storefront clinics, would also serve to make the drug available to many more patients than are currently using it. Opponents paint a dark picture in which a simple doctor’s letter, without time limits or dosages, becomes the key to easy distribution of cannabis, with supplies invariably finding their way to kids. Certainly, any regimen for medical marijuana that’s finally adopted should ensure that only those who demonstrably need the pain relief are getting it.

But in the end, Question 3 isn’t the right answer to a complicated policy issue. There are simply too many inherent problems in asking state officials to oversee a legalized system of growing and distributing a drug that hasn’t been subjected to the federal approval process.

Question 3’s heart is in the right place, and its architects have made a solid effort to learn from the mistakes of California and Colorado. But ultimately, the only truly safe way to legalize marijuana will be through the FDA, with doctors providing prescriptions and licensed pharmacists dispensing the medication.